Individual provider Active NPI

Jessica Moya, LCSW 67422

  • Social Worker
  • Pacoima, CA
National Provider Identifier
1497169890
Registry record updated Jul 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
67422 Issued in CA
Practice address
12450 Van Nuys Blvd
Suite 200
Pacoima, CA 91331-1391
Phone
(818) 896-1161
Fax
(818) 896-5069
NPI assigned
Jun 13, 2014
Last updated
Jul 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 67422 CA Primary

Addresses

Primary practice location

12450 Van Nuys Blvd
Suite 200
Pacoima, CA 91331-1391

Mailing address

12450 Van Nuys Blvd
Suite 200
Pacoima, CA 91331-1391
Phone (818) 896-1161

Other identifiers 3

IdentifierTypeStateIssuer
6758MedicaidCA
7068MedicaidCA
7420MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161207001003 CA Practitioner - Clinical Social Worker 4183904287 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cala Psychological Services IncGroup PAC ID 4082962261, 3 clinicians

Practice addresses (Care Compare)

595 E Colorado Blvd
Suite 428
Pasadena, CA 91101-2058
Phone (818) 839-1365

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC CurrentSince Dec 23, 2023 Accepting new patients
Cala Psychological Services, Inc CurrentSince Aug 18, 2022 Accepting new patients

Locations

595 E Colorado Blvd
Ste 428
Pasadena, CA 91101
Phone (818) 600-7312

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467676800000",
    "number": "1497169890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 VAN NUYS BLVD",
            "address_2": "SUITE 200",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311391",
            "telephone_number": "818-896-1161",
            "fax_number": "818-896-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 VAN NUYS BLVD",
            "address_2": "SUITE 200",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913311391",
            "telephone_number": "818-896-1161",
            "fax_number": "818-896-5069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYA",
        "first_name": "JESSICA",
        "credential": "LCSW 67422",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-13",
        "last_updated": "2016-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "67422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6758",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacoima, CA

Sources for this page

Verify at the official NPI Registry.